MHCDS Ideas in Action
I think the program's unique strength is how applicable it is for delivery system reform.
Using the material in your daily life happens almost immediately.
And I think the program has given our students a lot more flexibility in the kinds of things they can do and the kind of impact they can make.
Because I think the MHCDS program really opens your eyes to the way that things are done that may not necessarily be the way they should be done in the future.
And if you can be honest with the fact that that's the question we should be asking ourselves, then you can come up with innovative ways to change it for the future and improve the care delivery for people in the country going forward.
And what we decided to implement is called an ED split flow model.
That model actually puts patients in two different tracks.
The one track is where you think of us kind of like a normal high acuity track.
If you have a heart attack, if you have a stroke, you come right back to the emergency department.
Everything's done at the bedside.
All the providers cohort around the patient, and the care is provided there.
The second track is what we call a lower acuity track.
In that lower acuity track, the patients are actually moved throughout the process.
So they go into an intake area.
In that intake area, they see the provider, they see the nurse.
And then once they decide what the plan of care is, the patient then actually moves to the testing and the results waiting area and the registration area, versus having all that care being done at the bedside.
In terms of the capacity, that allowed us to expand the growth overall or the capacity for the emergency department to about 92,000 patients.
So it was a benefit in terms of reducing door to provider times, which came down dramatically, about 45%.
It also increased patient satisfaction, because one of the key markers of satisfaction for the patients is how quickly they see a doctor.
And then also a benefit to the hospitals from a financial standpoint, we were able to see a lot more patients.
One of the things that we recognized about five years ago was that the fourth leading cause of death in the United States was COPD.
It was quickly on the rise.
By now, it's actually the third leading cause of death.
As a prior finance person, I really hadn't known that.
You always heard about cancer.
You always heard about heart disease, but you never really heard about bronchitis and asthma growing to the point of really causing death at a large scale.
So we as a team, a multidisciplinary team focused around two doctors, a nurse, and a quality leader.
And myself as the finance person at the time, put together an initiative at Long Island Jewish Medical Center to improve the health and quality of life for people with COPD.
So we worked with the physicians who were expert in pulmonary disease.
We worked with our ambulatory site to make sure that we can connect people who were in the hospital who had had a significant exacerbation around pulmonary disease with an ambulatory physician on the outside of the hospital.
By facilitating those connections, we saw a dramatic increase in the compliance with their follow up care.
We saw a significant reduction in in-hospital mortality, and we saw a dramatic reduction in readmissions.
Diabetes is the number one cause of end stage renal disease and people needing dialysis or a kidney transplant.
So we focused on a group of high utilizers.
We enrolled people that had A1Cs greater than 8%.
What's the typical way that we were doing diabetes care before was here's your meter, here's your strips, keep a log.
Bring it back in with you.
Oh, by the way, our phone tree doesn't work very well.
It's difficult to get a hold of us.
Oh, you work a line job.
It's difficult for you to call between 8:00 and 5:00, but yet we expect you to do that.
Not very convenient.
So for some of our patients after they had their clinic visit, we would schedule a telephone follow up call with them.
And so our nurses typically will call them one or two times.
And if we can't get a hold of them, then we mark them as lost to follow up.
And then we may not hear from that patient until their next clinic visit, or they may end up in the ER.
So we provided them with remote patient monitoring to reduce their burden of disease.
This meter is like any other blood glucose meter.
So a patient will do a finger stick.
The result is read in about five seconds, and then it's communicated up to the cloud, comes down into our care team portal.
We were able to see that data in real time.
And then we were able to contact them if they were out of control or not monitoring, or having some kind of difficulty.
By providing that opportunity for bi-directional communication and also the data to flow in on the patient's time, not just our time, then you are better able to help people provide self-care, self-manage the disease.
And in the process of that, with a relatively short term pilot, our group was able to show a significant reduction in emergency room visits by about 70% and a significant reduction in patient utilization by close to 60% for that population.
And because of our training at Dartmouth, we were also able to look at time driven activities costing.
And when we did that, we found because of the missed call rate attempts, the cost of getting an actual blood sugar traditionally was close to $60 per blood sugar.
When you translate that then to using our remote patient monitoring technique, the cost of an actual blood sugar then was about $7.
Certainly the thing that I am most proud of is the ability of our students to be making an impact on the world.
And this is true of most of our graduates.
When you sit down and you see them two years out, three years out, five years out, and you say, how is your MHCDS journey impacting what you do these days?
And you get one of two answers, every day or every hour of every day.